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Hip disease in ankylosing spondylitis
Bert Vander Cruyssen1, Nathan Vastesaeger, Eduardo Collantes-Estévez
1Department of Rheumatology, OLV Hospital Aalst, Bornem, Belgium. Bvcruyssen@Gmail.com
Insights
Hip disease affects one-third of ankylosing spondylitis (AS) patients, often requiring hip replacement. Early assessment and anti-tumour necrosis factor (TNF) agents are recommended for active hip disease in AS.
Area of Science:
- Rheumatology
- Orthopedics
- Immunology
Background:
- Hip disease is a common and disabling complication of ankylosing spondylitis (AS).
- It affects approximately one-third of AS patients and can necessitate total hip replacement, particularly in young adults.
- Recent research has focused on the epidemiology, pathology, diagnosis, prognosis, and management of hip involvement in AS.
Purpose of the Study:
- To review recent studies on the diagnosis, prognosis, and therapeutic management of hip disease in patients with ankylosing spondylitis.
- To provide an updated overview of current understanding and clinical recommendations for hip involvement in AS.
Main Methods:
- Review of recent large-scale studies and clinical data on hip involvement in AS.
- Evaluation of diagnostic modalities including clinical examination, radiology, MRI, and ultrasonography.
- Assessment of treatment outcomes for anti-tumour necrosis factor (TNF) agents and surgical interventions.
Main Results:
- Hip disease in AS is more prevalent in patients with earlier disease onset and more severe axial disease.
- Diagnostic methods like clinical exam, radiology, MRI, and ultrasonography reveal different aspects of hip involvement.
- Anti-TNF agents show efficacy in pain relief and functional improvement for active axial and hip disease, though their effect on structural progression is unclear.
- Total hip replacement is indicated for end-stage hip disease.
Conclusions:
- Routine clinical assessment of hips is recommended for all patients with AS.
- Anti-TNF therapy should be considered for AS patients with NSAID-resistant active axial disease and concurrent hip disease.
- Prompt diagnosis and management are crucial to mitigate disability from hip disease in AS.
Purpose Of Review:
Hip disease occurs in about one-third of patients with ankylosing spondylitis (AS) and can often be disabling, necessitating total hip replacement in young adults. There have been recent articles on a number of aspects of this problem, including the epidemiology and pathology. The most recent studies on diagnosis, prognosis and therapeutic management are reviewed here.
Recent Findings:
Several large studies have evaluated the prevalence and outcome of hip involvement in AS. Hip involvement can be diagnosed clinically, radiologically, by MRI or by ultrasonography. These examinations highlight different aspects of hip disease in AS. Hip disease is more prevalent in patients with a younger disease onset and seems to be associated with more severe axial disease. Antitumour necrosis factor (TNF) agents are helpful for pain relief and improvement of function in patients with active axial and active hip disease. However, it is not clear whether this treatment option can prevent progression of structural damage. In case of end-stage hip disease, total hip replacement should be considered.
Summary:
In patients with AS, the hips should be routinely assessed, at least by clinical examination. Anti-TNF therapy should be considered in patients with NSAID-resistant active axial disease who have concomitant hip disease.
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